Provider Demographics
NPI:1184037442
Name:REDUS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:REDUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-0733
Mailing Address - Country:US
Mailing Address - Phone:918-633-5198
Mailing Address - Fax:
Practice Address - Street 1:1025 E GRAYSON AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4536
Practice Address - Country:US
Practice Address - Phone:918-227-2622
Practice Address - Fax:918-227-4644
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor